Provider Demographics
NPI:1316018492
Name:HODGSON, DOUGLAS JOHN (OD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JOHN
Last Name:HODGSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5830 E 2ND ST # 96438
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4308
Mailing Address - Country:US
Mailing Address - Phone:307-277-5282
Mailing Address - Fax:
Practice Address - Street 1:2552 E 3RD ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-7882
Practice Address - Country:US
Practice Address - Phone:812-332-3432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY268T152W00000X
IN18003064A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY116258600Medicaid
WY116258600Medicaid
WY308603Medicare ID - Type Unspecified